Secondary Partial Mastectomy with Contralateral Sentinel Lymph Node Biopsy for Ipsilateral Breast Cancer Recurrence after Conservative Surgery: Report of 2 Cases

Wan Wook Kim; Young San Jeon; Su Hwan Kang; Jeong Eon Lee; Se Kyung Lee; Sung Mo Hur; Sung Hoon Kim; Seok Jin Nam; Jung-Hyun Yang; Soo Jung Lee

doi:10.4048/jbc.2010.13.3.305

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Kim, Jeon, Kang, Lee, Lee, Hur, Kim, Nam, Yang, and Lee: Secondary Partial Mastectomy with Contralateral Sentinel Lymph Node Biopsy for Ipsilateral Breast Cancer Recurrence after Conservative Surgery: Report of 2 Cases

Case Report

Journal of Breast Cancer

Journal of Breast Cancer 2010; 13(3): 305-310.

Published online: 29 September 2010

DOI: https://doi.org/10.4048/jbc.2010.13.3.305

Secondary Partial Mastectomy with Contralateral Sentinel Lymph Node Biopsy for Ipsilateral Breast Cancer Recurrence after Conservative Surgery: Report of 2 Cases

Wan Wook Kim, Young San Jeon¹, Su Hwan Kang¹, Jeong Eon Lee, Se Kyung Lee, Sung Mo Hur, Sung Hoon Kim, Seok Jin Nam, Jung-Hyun Yang, Soo Jung Lee¹

Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

¹Department of Surgery, Yeungnam University College of Medicine, Daegu, Korea.

Corresponding author (crystallee@medical.yu.ac.kr)

Received 12 January 2010 Accepted 25 June 2010

Abstract

Mastectomy has been known to be the best strategy for treating in patients with ipsilateral breast cancer recurrence (IBCR) after conservative surgery. For the cases with a small recurrent cancer which is found in the majority of cases on the regular check-up, the patients' desire for breast conserving surgery is increasing. Some recent studies have reported patients with IBCR might receive a second partial mastectomy, when a good local control can be predicted. It is not obvious that sentinel lymph node biopsy (SLNB) in the treated breast is feasible because the previous axillary dissection and/or irradiation may affected the pattern of lymphatic flow. Because of its high accuracy, SLNB may be safely performed for the patients with IBCR in the treated breast. Interestingly, there are reports that SLNB in this condition has revealed that the sentinel lymph node(s) can be found in the opposite side. We reported two cases in which contralateral SLNB were performed during the secondary partial mastectomy for the IBCR after breast conserving surgery.

Keywords: Contralateral sentinel lymph node biopsy, Ipsilateral breast cancer recurrence, Secondary partial mastectomy

Figures and Tables

Figure 1

Preoperative ultrasonogram revealed about 0.5 cm size ill defined irregular hypoechoic nodular lesion at right lower inner area.

Figure 2

In preoperative lymphoscintigraphy, sentinel lymph node (arrow) was detected in the contralateral axillary level I area.

Figure 3

Preoperative ultrasonogram revealed about 1.0 cm size irregular microlobulating hypoechoic mass at upper outer quadrant of right breast. This lesion was adjacent to previous surgical site.

Figure 4

Dynamic image of the involved breast and axillary region was obtained for 10 min after injection of radiotracer. Focal hot uptake with lymphatic flow was noted in the ipsilateral internal mammary area (arrowhead) and contralateral axillary level I area (arrow).

Figure 5

There was no hypermetabolic lesion in the internal mammary area and the other sites on immediate postoperative PET-CT (A). But, 6 months later after operation, PET-CT revealed multiple hypermetabolic lesions in the left internal mammary area (B) and left hemithorax (C).

Table 1

Summary of each case regarding characteristics, operation, pathology and treatment

LN=lymph node; IDC=invasive ductal carcinoma; ER=estrogen receptor; PR=progesterone receptor; HER2=higher human epidermal growth factor receptor 2; SLNB=sentinel lymph node biopsy.

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